Late acute renal failure due to bilateral kidney infiltration by ALL as single manifestation of relapse after allogeneic transplantation.

摘要

Acute renal failure (ARF) is a common complication following allogeneic hematopoietic SCT (HSCT). Numerous conditions may be associated with early ARF including pre-existing kidney dysfunction, hypertension, TBI, sepsis, sinusoidal occlusion syndrome, dehydration, acute GVHD, nephrotoxic drugs and microangiopathic syndromes, which include both thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. The incidence of microangiopathic syndromes ranges from 2 to 21% after allogeneic HSCT, and identified primary risk factors include TBI and use of calcineurin inhibitors. Clinically, thrombotic thrombocytopenic purpura tends to occur early, often within the first 90 days of transplant, whereas hemolytic uremic syndrome seems to occur much later. Direct malignant infiltration of the kidneys at diagnosis of acute leukemia is an extremely rare cause of early ARF and has been described in a few children only.